Sertraline Treatment of Panic Disorder: Response in Patients at Risk for Poor Outcome
J Clin Psychiatry 2000;61(12):922-927
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: More than one third of panic
disorder patients have a chronic and/or recurrent form of the
disorder, accounting for much of the individual and societal cost
associated with the illness. Six clinical variables have been
most consistently identified as high-risk predictors of poor
outcome: (1) panic severity, (2) presence of agoraphobia, (3)
comorbid depression, (4) comorbid personality disorder, (5)
duration of illness, and (6) female sex. No published research
has systematically examined the differential antipanic efficacy
of selective serotonin reuptake inhibitors in patients at high
risk for poor outcome.
Method: Data were pooled (N = 664) from 4
double-blind, placebo-controlled studies of the efficacy of
sertraline for the treatment of DSM-III-R panic disorder. Two of
the studies were 12-week fixed-dose studies with starting daily
doses of sertraline, 50 mg, and 2 were 10-week flexible-dose
studies with starting daily doses of sertraline, 25 mg. All other
study design features were the same, except for the exclusion of
women of childbearing potential in the 2 fixed-dose studies.
Exclusion of patients with marked personality disorders and
depression meant that only 4 of the poor-outcome variables could
Results: Clinical improvement was similar
for patients treated with sertraline whether or not they carried
an agoraphobia diagnosis, had a duration of illness > 2 years,
or were female. Patients with high baseline panic severity had
significantly (p = .01) less improvement on the endpoint Clinical
Global Impressions-Improvement (CGI-I) scale than patients with
moderate severity, although the Clinical Global
Impressions-Severity of Illness scale change score was higher in
the patients with high severity (-2.00 vs. -1.31). For patients
with 3 or more high-risk variables, there was a modest, but
statistically significant, tendency for reduced global
improvement (endpoint CGI-I score of 2.7 for the high-risk vs.
2.4 for the non-high-risk group; p = .017), although the
high-risk group actually had a similar endpoint reduction in
frequency of panic attacks (82%) compared with the non-high-risk
Conclusion: Treatment of panic disorder with
sertraline was generally effective, even in the presence of
baseline clinical variables that have been associated with poor
treatment response. The main limitations of the analysis were the
reliance on pooled data from 4 studies (even if the designs were
similar) and our inability to examine the impact of depression
and personality disorders on response to treatment because of the
exclusion criteria of the clinical trials.